State of Arizona Affidavit of Shared Residence

State of Arizona

Affidavit of Shared Residence

Student Name: ___________________________________________________

Parent/Legal Guardian Name:

_______________________________________

School Name: ___________________________________________________

School District or Charter Holder: _______________________

____________

Name of Arizona Resident: _________________________________________

I, (resident name) ___________________________________ swear or affirm that I am a resident of the State of

Arizona and that the persons listed below reside with me at my residence, described as follows:

Persons who reside with me: ________________________________________

Location of my residence: __________________________________________

I submit in support of this attestation a copy of the following document that displays my name and current

residence address or physical description of my property:

Valid Arizona driver’s license, Arizona identification card or motor vehicle registration

Valid Arizona Address Confidentiality Program authorization card

Real estate deed or mortgage documents

Property tax bill

Residential lease or rental agreement

Water, electric, gas, cable, or

phone bill

Bank or credit card statement

2 wage statement

Payroll stub

Certificate of tribal enrollment (506 Form) or other identification issued by a recognized Indian tribe in

Arizona

Documentation from a state, tribal or federal government agency (Social Security Administration,

Veteran’s Administration, Arizona Department of Economic Security)

Consular identification card issued by a foreign government as a valid form of identification if the

foreign government uses biometric v

erification techniques in issuing the consular identification card

Printed Name of Affiant: _________________________________